Message to heart patients: It's safe to have sex

HEALTH

Sex is safe for most people who have suffered a heart attack or have some other kind of heart or vascular condition, as long as they take a few precautions, according to the first medical guidelines on the subject.

Don't attempt sex if you're so out of shape you can't climb a flight of stairs, for example, and don't mix nitroglycerin with erectile dysfunction drugs. Also, don't cheat on your spouse.

"You can imagine an extramarital affair might raise your blood pressure," said Dr. Elyse Foster, a UCSF cardiologist and one of the authors of the new guidelines.

"There are probably a lot of misconceptions about what is safe to do and what is not" for people with cardiovascular disease, Foster said. "Generally, if the patient is stable and on medications and minimally symptomatic, sexual activity is safe."

The precautions, released Thursday by the American Heart Association, address specific recommendations for a dozen kinds of cardiovascular conditions - from heart attack to coronary artery disease, irregular heartbeats and congenital heart defects.

Fretting about sex

Patients with cardiovascular disease, and their partners, often worry that sexual activity will trigger a heart attack or prompt symptoms like chest pain. In fact, the chances of sex doing that kind of damage are low. Only about 1 percent of all heart attacks in the United States happen during sex, according to multiple studies.

Still, there are risks because blood pressure generally increases during the activity and spikes during orgasm - potentially overwhelming the cardiovascular system and leaving the heart or brain starved for oxygen.

A good rule of thumb is that if a person with heart disease is cleared for any kind of physical activity, it is almost definitely safe to have sex, Foster said.

"With some reasonable common-sense precautions, the vast majority of people with heart conditions can enjoy very satisfying and high-quality sex lives," said Dr. Anthony Steimle, chief of cardiology at Kaiser Santa Clara.

The most important recommendation may be the simplest: that patients and doctors have conversations about sex, a topic that many people on both sides of the examination table may be reluctant to bring up.

Patients may be ready to have sex again just a few days after a stroke or heart attack - or they may be advised to wait a few weeks or months after major bypass surgery. Doctors will almost always perform stress tests on patients recovering from a heart or vascular incident, and those tests should reveal whether they're fit for sex.

Tiburon resident Noah Griffin wanted to have sex just a few days after his stroke six years ago, but his wife was worried that the activity might not be safe. He eventually won - he says he was eager to prove that everything was working after his health scare - but months later, the medication to lower his blood pressure started giving him erectile dysfunction.

That's another important problem for doctors to address with cardiovascular patients, researchers say.

"I had a guy who wanted me to take him off his heart failure medications because he wanted to try Viagra," Morris said. "I told him, 'I know you want one more time, but we want to keep you alive.' It's not really fair."

Adjusting the meds

Griffin's problem was resolved by cutting the dosage of his blood pressure medication, and he now reports a happy sex life with his wife. Other men may be able to use drugs like Viagra, as long as they're careful the medication doesn't interfere with whatever else they're taking, like nitroglycerin.

"Everyone should talk to their doctor about this. Don't be shy," said Griffin, 65. "It's that closeness with your wife, you want to re-establish it as soon as you can."

The American Heart Association guidelines came from dozens of studies on sexual activity and cardiovascular disease and apply to both men and women. But the authors noted that the research focused heavily on men, most of them in their 40s, 50s or 60s and in monogamous relationships with women. More research should be done on women, older adults and gay men, cardiologists say.

"The people who have been studied the most - young, married men having sex with their wives - are not the ones most at risk," Foster said.

While there's no doubt that physical exertion can be dangerous for some people, especially if they have a serious heart condition that isn't being treated, the risk of having a heart attack, stroke or even dying during sex is low, partly because most people don't spend much time having sex.

The risks are low

Dying during sex is rare. In one study, about 0.6 percent of deaths happened during sex. Curiously, roughly 90 percent of those who died were men, and 75 percent of those men were having extramarital sex at the time - often with a younger partner, studies found.

"You're probably going to have a higher heart rate and greater exertion during a sexual encounter with someone who isn't your wife," Foster said.